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How to help avoid litigation

Johnson & Johnson is delighted to bring you this article, with the aim of supporting the ongoing CPD needs of dental healthcare professionals in improving and maintaining the oral health of their patients.

This article is equivalent to one hour of Enhanced CPD. To provide feedback on this article, please contact dentalcpd@its.jnj.com

Aims and objectives

The aim of this article is to consider the importance of effective note-taking and how to deal with complaints effectively from the onset, in an effort to resolve any perceived patient problems at the earliest possible stage.

On completing this CPD session, the reader will:

• Understand the incidence of complaints in dentistry and why it may be a growing problem

• Understand what constitutes a complaint in dental practice

• Understand the General Dental Council’s expectations of the dental team

• Understand how to address a patient’s complaint effectively from a practical perspective

• Understand the significance of keeping accurate and contemporaneous records, and how to do so.

How to help avoid litigation

Data on written complaints in the NHS reveal that between 1 April 2016 and 31 March 2017, 13,493 complaints were made in England about NHS dentistry.1 This is almost double the figure calculated for 2015/2016, which stood at 7,664 complaints,2 indicating what might be a worrying trend. But why should this be? One possible answer, as stated succinctly by D’Cruz (2010), is: ‘The rise of consumerism means patients’ expectations of their care is higher and patients are ever more ready to question the care they have been given.’3

Handling complaints

Perhaps the best thing to do at this juncture is define what constitutes a complaint. According to Young (2015): ‘Basically it is an expression of dissatisfaction that requires a response. What do patients complain about? Basically, anything and everything. They will complain about:

• ‘Treatment

• ‘Service: cost, pain (continuing, or being ignored), conduct (including rudeness), getting access or not getting access to treatment, giving or not giving consent

• ‘Communication: lack of it is usually at the heart of most complaints. Most complaints are about dentists, but some are about other members of the dental team.’4

Complaints may come about for a variety of reasons but, in essence, it may be fair to consider that: ‘A degree of motivation is required for any patient to register dissatisfaction. The greater the gap between expectations and outcome, the higher the level of motivation to complain.’3

Once a complaint has been made, Young (2015) advises that it is best not to consider whether it is a serious matter; rather, regard all complaints as significant, so that there is no way the patient may perceive you think it is unimportant.4

The General Dental Council’s (GDC) ‘Standards for the dental team’ states that registered dental professionals must ensure that that:

• There is an effective complaints procedure in place for patients to use

• The procedure is always followed

• A patient’s right to complain is respected

• Patients who complain are given a prompt and constructive response.5

If you receive criticism from a patient verbally, try to get them to put it in writing, as it is good to have such a record4 (more on the significance of record keeping will be covered further on).

Next, acknowledge the complaint in writing and send the letter to the patient as quickly as possible, and no longer than 5 working days from the date of the complaint. Within the missive, summarise what you perceive to be the problem(s), to ensure you and the patient are on the same wavelength, explain what you are going to do next, and the date by which they can expect to hear from you again.4

Once the fact-finding process has been completed, it is time to report back to the patient. This can be done in writing or face-to-face. If the latter is chosen, have a colleague sit in with you, such as the practice manager, and invite the patient to bring someone with them too, if they want support.4

How this meeting is conducted is crucial, since: ‘It is at this stage that you have the opportunity to show them that you are totally professional, reasonable and unbiased, which hopefully will impress them, and this then may greatly influence their opinion of you in the future. Conducting yourself well at this stage could not only help to (re-) build their trust in you as a dentist, but could also win their respect for you as a person.’4

Before ending the meeting, let the patient know what steps will be taken next. For example, the matter may now be at its end, or you may take learnings from it and be set to make changes within the practice to ensure the same problem does not arise again. Lastly, confirm in writing what was discussed during the meeting and any action points that arose from it.4

The role of records

Young (2015) wrote that a dental health care professional (DHCP), ‘[…] can only successfully defend a complaint if you have comprehensive, contemporaneous records to support your case, and these begin with the patient records. A patient’s notes or records should always contain comprehensive details about:

• ‘Their personal details

• ‘Their full, up-dated medical history

• ‘A full dental history

• ‘A social history

• ‘Any current dental complaints

• ‘Treatment plans and the likely cost

• ‘Their consent to any treatment

• ‘What treatment they have received and why

• ‘The type, quantity and location of any local analgesia, general anaesthesia or sedation used

• ‘What treatment they have refused and why

• ‘Any advice they have been given

• ‘Whether or not they accepted the advice

• ‘Information about any referrals

• ‘Details of any unusual discussions or conversations, not just between the clinicians and the patient, but also between the patient and employees

• ‘Financial transactions.’4

Putting all of this in perspective, he continued; ‘Poor records will make it more difficult for you to fight off a complaint. Excellent records won’t guarantee you’ll win, but they will make it less likely you’ll lose.’4

Meanwhile, Principle 4 of the GDC’s ‘Standards for the Dental Team’ enshrines the concept of keeping records, with the following: ‘You must make and keep contemporaneous, complete and accurate patient records.’5

The guidance document continues:

• ‘4.1.1 You must make and keep complete and accurate patient records, including an up-to-date medical history, each time that you treat patients. Radiographs, consent forms, photographs, models, audio or visual recordings of consultations, laboratory prescriptions, statements of conformity and referral letters all form part of patients records where they are available.’

• ‘4.1.2 You should record as much detail as possible about the discussions you have with your patients, including evidence that valid consent has been obtained. You should also include details of any particular patient’s treatment needs where appropriate.’

• ‘4.1.3 You must understand and meet your responsibilities in relation to patient information in line with current legislation. You must follow appropriate national advice on retaining, storing and disposing of patient records.’

• ‘4.1.4 You must ensure that all documentation that records your work, including patient records, is clear, legible, accurate, and can be readily understood by others. You must also record the name or initials of the treating clinician.’

• ‘4.1.5 If you need to make any amendments to a patient’s records you must make sure that the changes are clearly marked up and dated.’

• ‘4.1.6 If you refer a patient to another dental professional or other health professional, you must make an accurate record of this referral in the patient’s notes and include a written prescription when necessary.’5

Learning from mistakes

Despite the best efforts of the DHCP, there is a growing likelihood that a complaint will be made by a patient at some point in a dental career.3,4

Putting a somewhat positive spin on this that is, perhaps, worth keeping in mind through any such difficulties, Sharma (2017) wrote: ‘In the end a complaint should be used as a learning experience. It is fruitful to appropriately reflect on the entire situation to consider how the complaint initially arose, the manner in which it was handled, the resolution, how effective was the practice policy and procedures, ways in which anything can be improved and then making the required changes.’6

Adding to this notion, D’Cruz (2010) stated: ‘The mark of a professional is to acknowledge when things go wrong, communicate this to patients with humility and to learn from the problem to ensure that, where possible, it does not occur again.’3

QUESTIONS: 

References

  1. Data on Written Complaints in the NHS 2016-17. Health and Social Care Information Centre 2017

  2. Data on Written Complaints in the NHS 2015-16. Health and Social Care Information Centre 2016

  3. D’Cruz L. Risk management in clinical practice. Part 1. Introduction. BDJ 2010; 209(1): 19-23

  4. Young MR. How to turn complaints into compliments. BDJ Team 2015; 3(3): 17-18

  5. Standards for the Dental Team. General Dental Council 2016

  6. Sharma P. The professional approach to handling complaints. BDJ Team 2017; 4(2): 15-16